肿瘤专科血液复检规则的初步建立和评价

Establishment and evaluation of re-examination rules for blood cell morphology analysis in the patient with tumor

目的用Sysmex XE-2100血液分析仪对肿瘤患者的外周血标本进行分析并涂片镜检,探讨适用于肿瘤患者的血液复检标准。方法用SysmexXE-2100血液分析流水线,随机检测肿瘤患者1 200例,同时涂片镜检,观察细胞形态并进行显微镜WBC分类。参考国际血液学复审协作组和我国血细胞分析复检标准制定协作组提出的复检规则,拟定了改良的筛选方案,计算其真阳性率、假阳性率、真阴性率、假阴性率和涂片复检率。选定200例样本验证新建立的复检标准。结果应用最初的改良筛选方案,真阳性率为34.5%,假阳性率为19.5%,真阴性率为42.7%,假阴性率为3.3%,涂片复检率为54.0%;应用改良的筛选方案,真阳性率为20.6%、假阳性率为10.3%,真阴性率为64.3%,假阴性率为4.8%,涂片复检率为30.9%。结论针对肿瘤专科医院患者建立的血液复检规则假阴性率低于最大可接受限5%,复检率下降23%,提高了工作效率。

Objective To establish and evaluate the re-examination rules suitable for blood cell morphology analysis of the patient with tumor based on the blood cell analysis with Sysmex XE-2100 hematology analyzer and blood smear under microscope.Methods A total of 1 200 blood samples from tumor patients were examined with Sysmex XE-2100 hematology analyzer,and the corresponding blood smear was performed the observation of cell morphology and manual WBC differential analysis under microscope.According to the review criteria recommended by International Consensus Group for Hematology Review and China Cooperation Group of Formulation Review Criteria for Automated CBC and WBC Differential Analysis,the new modified re-examination rules were established,and the true positive ratio（TP）,false positive ratio（FT）,true negative ratio（TN）,false negative ratio（FN） and the rate of smear review were calculated.Finally 200 blood samples were selected to validate the new re-examination rules.Results According to the initial modified re-examination rules,the TP,FP,TN,FN and the rate of smear review were 34.5%,19.5%,42.7%,3.3% and 54.0% respectively.After a series of refinements were made,the TP,FP,TN,FN and the rate of smear review were 20.6%,10.3%,64.3%,4.8% and 30.9% respectively.Conclusion After the new modified re-examination rules were applied for the patients with tumor,the work efficiency was improved,the FN below the acceptable limit of 5% and the rate of smear review decreased 23%.